Anthem Accreditation Director, PBM PS3100 in Green Valley, Arizona
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Accreditation Director, PBM
Responsible for leading all accreditation activities for a line of business, region of the company, standards set, and/or enterprise wide which are necessary for attaining and maintaining accreditation from various accrediting organizations, such as URAC and NCQA.
Primary duties may include, but are not limited to:
Interfaces with internal and external clients, quality committees, and departments in the review of quality improvement data and in the implementation of appropriate interventions to effect improvement.
Manages the overall accreditation processes and resources required to successfully lead the team.
Evaluates, interprets and summarizes accreditation guidelines and manages the process for accreditation activities.
Identifies appropriate resources and accountabilities for project teams involved with accreditation.
Conducts the ongoing evaluation and interpretation of quality standards and accreditation standards to ensure compliance through reporting and measurement studies/ methodologies.
Serves as expert resource to quality committees and business owners across the organization.
Leads and provides oversight of quality studies/projects. Facilitates project management and oversees comprehensive accreditation work plans by establishing deliverables, accountabilities, and timelines for team members. Performs quantitative and qualitative analysis of quality related data and reports activities, improvements, and recommendations to the quality committee.
Requires BA/BS in a health care field, and 3-5 yrs healthcare-related experience in addition to 5 years experience in a QA/QI related position, project management, and strong quantitative, qualitative and analytical skills or any combination of education and experience, which would provide an equivalent background. Successful NCQA/URAC accreditation process completion and continuous process improvement experience in an NCQA UM and URAC PBM accreditation experience setting highly preferred. Registered nurse highly preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
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Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Accreditation Director, PBM PS3100
Location: arizona-Green Valley
Requisition ID: PS3100